Dry skin is recognizable by its tight, rough feel and its dull appearance. It''s a nuisance, and folks will stop at nothing to scratch an itch — which explains why your co-worker uses a doorframe to reach that itch located between his or her shoulder blades.

Michael Heffernan, MD, Washington University dermatologist at Barnes-Jewish Hospital, says about one-fifth of the 40-50 patients he sees each day have nothing more than dry, irritated skin.

"Most people who go to their doctor because they''re itching are either concerned that they''re having a reaction to a medication, or they''re allergic to something, or they think they''ve got psoriasis. Their problem is dry skin," Dr. Heffernan says. "And, 95 percent of people who are sent to me for itching by other doctors — their only problem is dry, irritated skin."

The main culprits of dry skin are excessive hot showers, harsh bar or liquid soap, harsh laundry detergents, and forced-air heating.

"Most people in the United States don''t believe it, but we wash and bathe too much," Dr. Heffernan says. "It''s all because of Madison Avenue advertising telling us that we stink. People bathe too often, for too long, with too harsh of soaps. Of the main soaps that are advertised, Ivory, Zest, Dial, Irish Spring and Coast are heck on the skin.

"By and large, the reason people use them is because they advertise well and they''re not terribly expensive."

Dr. Heffernan says those types are soaps are OK if you''re a teenager. During adolescence the body sweats mores and produces more body oil.

When a person gets older, however, the body perspires less and makes less of its own natural body oil, he says. Soaps such as Dove or Oil of Olay should be used.

Dr. Heffernan says adults should even consider bathing or showering every other day during the winter. If that''s out of the question, he suggests showering or bathing for a shorter period of time and washing just the face, armpits, groin and feet every time.

"By shorter periods of time, I mean less than five minutes, and with cool — not hot — water," he says. "The hotter it is, the more it strips the natural oils off the skin. Immediately upon leaving tub, we should apply moisturizer, the thicker the better.

"The truth is, you can bathe as much as you want as long as you moisturize afterward," he says. "If you feel better bathing two or three times a day, as long as you keep it short and moisturize, that''s fine. If you don''t moisturize, you should bathe every other day. If you''re a mechanic or work in a factory, you can build a reason for showering every day."

Moisturizers and lotions are two different things. Dr. Heffernan says the most effective moisturizer is Vaseline Petroleum Jelly. It provides a coating on the skin, which water can''t escape. Vaseline is equal to four applications of a crème like eucerin or cetaphil. The problem with Vaseline is it leaves a person feeling greasy, which is why it''s best to apply before going to bed.

He says lotions tend to be the most popular type of moisturizer; however, they contain more water so they''re less effective.

Dr. Heffernan says a person can further irritate the skin by improperly drying when leaving the tub.

"When you get out of the tub, you don''t want to make yourself ''Zest-fully'' clean — where you''re taking the towel and rubbing yourself raw," he says. "You also don''t want to use a loofa or buff puffs. You want to leave a path of water, little droplets of water on your skin. That''s when you lock it in with a moisturizer. If your skin is really red, itchy and scaly, then you probably have a form of dermatitis."

Outside of moisturizing after bathing, Dr. Heffernan says there aren''t many lines of defense in stopping dry skin.

He''s often asked about keeping the body hydrated by drinking plenty of water or running a humidifier.

"Unfortunately, you can drink water until your bladder bursts, and it won''t make any difference in the dryness of your skin," Dr. Heffernan says. "The water concoction is something your mother dreamt up because she wanted you to drink more water. It''s just like when she told you not to drink soda because you''ll get acne. She was lying to you then, too.

"Humidifiers are great, except for the problem that bacterium grow in them. We generally don''t recommend them," he says. "It''s impossible to keep them clean. The better thing to do is put some moisturizer on the skin rather than try to get it through the air."

Instead of a humidifier, Dr. Heffernan suggests adding a few more plants to the home or office. Plants act like a humidifier without the bacteria. If they''re watered, they can make a difference.

(This story was originally published in the January 27, 2003, edition of BJC Today. Written by Brian Bretsch.)

For an appointment with a Barnes-Jewish Hospital TOP-DOC, call 314-TOP-DOCS (867-3627) or toll free 1-866-867-3627.